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Home My WebLink About32560-Z 1 TOWN OF SOUTHOLDi BUILDING DEP ARTMEN TOW~ HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www.northfork.net/Southold! PERMIT NO. 3 J (\6 0 b , BUILDING PERMIT APPLICA nON CHECKLIST Do you have or need the following, before applying? Board of Health y 3 sets ofBuilding Plans II'" Planning Board approval Survey v' Check / Septic Form II'" N.Y.S.D.E.C. Trustees Contact: ,20-& V .?O3 .ct:;)-:-~ f'03I New 4D,;/.. 'ft/21lt./ nil! ,20~ I . IV (I, 20-.f).f Examined Approved Disapproved ale Expiration t /11 I /1/'1"(1'" ~(.7(.. r I i I OCT 2 7~6 , I t, l'~;,.Ihi: a~pJieation.M~~~ ~~i completely fille sets 0 ' , 'ccurate plm pI . Ie, Fee accordmg to s b, Plot plan showing location oflot and ofbuildi areas, and waterways. /' c. The work covered by this application may t be commenced before issuance of Building Permit. d. Upon approval of this application, the B ding Inspector will issue a Building Permit to the applicant. Such a permit .shall be kept on the premises available for inspe n throughout the work. e. No building shall be occupied or n n whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall ex r the work authorized has not commenced within 12 months after the date of issuance or has not been completed w" months from such date, If no zoning amendments or other regnJations affecting the property have been enacted in the i eri the Building Inspector may authorize, in writing, the extension of the permit for an addition six mouths. Therearter, a new rmit shall be required. APPLICA nON IS HEREBY ADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the To\\> of SouthoId, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of. uildings, additions, or alterations or for removal or demolition as herein described. The applicant agrees to comply with at pplicable laws, ordinances, building code, housing code and regulations, and to admit authorized inspectors on premises and in building for necessary inspections, --.--.., Date g'- I y 20 C1 " '- ewriter or in ink and submitted to the Building Inspector with 3 e ule. on premises, relationship to adjoining premises or public streets or u.-1t'Y/I<j 17 ieant) see, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises 014/ f ~ ( on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized 0 cer 1t..t4 (Name and title of corporate officer) Builders License No, Plumbers License No. Electricians License No, Other Trade's License No. YlJ.1GJ fI J 1'/2. mn <; (, r.9 -/3 I. Location of land on which propose 'LfC; lV'i1 House Number Street work willJle done: ~v / L!?t/v'14 c e. JtJt.-</(p/c:/ Hamlet ''-., County Tax Map No. 1000 Section ~ t Subdivision ~Jtitt~w" (Name) Block tt7/ Filed Map No. Lot 3.7 Lot .~ State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existinguseandoccupancy ':;'/niu. FJ4rI1i7 j/~5r~ b. Intended use and occupancy )'",?k F~,'~ vefr~ 3. Nature of work (check which applicable): New Building Repair t./ Removal Demolition Addition./' Alteration ~ OtherWork ~ (Description) 4. Estimated Cost 0 lco ax:; ,0 d ./ 5. If dwelling, number of dwelling units I , If garage, number of cars #4 Fee (To be paid on filing this application) Number of dwelling units on each floor 6. Ifbusiness, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front ~ 7 I Height '2... :1 ' Number of Stories "2- Dimensions of same structure with alterations or additions: Front 7 f? / '"Z.. /, Depth 'Z.:5 / Height z.. Number of Stories I Rear {7 Depth t./ / / , " Rear 7f-z 8. Dimensions of entire new construction: Front Height Number of Stories Rear Depth 9. Size oflot: Front /("O.}(9 / Rear / '/7, 7 ] / t3 3,(,/ ( Depth /'/ 7 1/ 2. ( 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated \ ./ 12. Does proposed construction vlolate any zoning law, ordinance or regulation? YES_NO--1L- ( 13. Will lot be re-graded? YES_NO_ WiU excess fill be removed from premises? YES_NO__ l1'/o:f.tu.-#J,. ~ ,.~ '''-;/1. If . I{~J ~?2- ~r 'I 14. Names of Owner of premIses vb. H'IIuJf/I "- Adaress", y rvylt>>....' Phone No. 212 -//7)- J 70" Name of Architect j1f,,&:.fz.<./ L1~4r'-r- Address~"It'?h...."vy PhoneNo ?1/ 2,~'7-9Y'7~ NameofContractorJH1MJEs-1/ 217.... , Address.tb~ /rf7 ~~yPhoneNo. t.J/ ~r.:J Y~7f "~J7 .15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES _NO / * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.e. PERMITS MAY BE ~QUIRED. \ b. Is this property within 300 feet of a tidal wetland? * YES_NO-L '" IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation ~and distances to property lines. .,/ 17. If elevation at any point on property is at ~P7J"~10 m.. ust provide topographical data on survey. e.- STATE OF NEW YORK) I"~) I SS. " COUNTYOF~((;'A ) . I . . ~ 1-, 1/. 2. ,'L" , being duly swo depose nd says that (s)he is the applicant (Name of individual signing contract) above named, 0fi1/r h-Vf v 1/ (Contractor, Agent, Corporate Officer, etc.) (S)He is the of said owner or owners, and is duly authorized to perform or have performed the said work an~o make and file this application; that all statements contained in this application are true to the best of his knowledge and be . and that the work will be performed in the manner set forth in the application filed therewith. swqrny before me t~ \ { day of CA-~ -t- 20 ~ __(~___~1~.~ ~~ Notary Public ~ - ~', .J I " . . B~! ;J 't/i:ci7 01 .